建立的初级保健使用与术后死亡率的关联 紧急通用外科手术程序后
Sanford E Roberts1, Claire B Rosen1, Luke J Keele1
1Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia.
JAMA surgery
|July 19, 2023
概括
手术前获得初级保健服务与接受紧急整体手术的医疗保险患者的死亡率降低有关. 虽然黑人患者的初始住院死亡率没有差异,但黑人和白人患者的长期存活率都有所改善.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 外科手术的结果
- 健康差异 在健康上的差异
背景情况:
- 初级保健短缺影响了数百万人,特别是医疗保险受益者.
- 这些短缺对外科手术结果的影响仍未得到充分研究.
研究的目的:
- 调查手术前初级保健利用率和手术后死亡率在接受紧急整体手术 (EGS) 的老年黑人和白人成年人之间的关联.
主要方法:
- 在2015-2018年期间接受EGS的Medicare患者 (≥66岁) 的回顾性队列研究.
- 分析包括风险调整,并在多次术后间隔 (住院至180天) 检查死亡率.
- 评估了根据种族对效果的修改.
主要成果:
- 以前接受初级保健的患者在住院 (19%),30天 (27%) 和180天 (25%) 的死亡率显著降低.
- 初级保健利用与30日,60日,90日和180天黑人和白人患者的死亡率降低有关.
- 对于死亡结果,种族和初级保健暴露之间没有发现显著的相互作用.
结论:
- 手术前的初级保健准入与紧急整体手术后的生存率提高有关,特别是在长期.
- 虽然黑人患者的初始住院死亡率没有显著差异,但跨种族群体观察到长期益处.
- 这些发现强调了初级保健在减轻手术风险和改善老年人治疗结果方面的重要性.
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